Staffing a doctor's office during COVID-19

Miscellaneous and Personal Stuff I Must Share
1

Continuing the discussion from The Nahployment 'Crisis':

We have had our short-staffed sign up for six months. Lack of staff is adversely affecting patient care. This translates to wait times upwards of twenty, sometimes forty minutes for walk-in patients (only seeing the physician gets a scheduled appointment, other services are walk-in). Multiple patients have derided management to my face, perhaps unaware that I am management just covering the desk. We have fired three patients who lost their temper and cursed out staff.

We have essentially had two full-time openings for four months (!). This is an office that normally employs five full-time employees, and three part-time.

Since March I personally called no less than three hundred applicants. Roughly eighty interviews made it onto our schedule. Fifteen showed up.

Seven were viable candidates, by which I mean they are okay with the description, hours, and benefits. Of those seven we offered to hire six (one no-showed the first interview and we offered someone else the job that afternoon). Not at once you see, when we make the offer we then have to wait two weeks for them to give notice.

Of the six who took the offer, two showed up for their first day. Both were emailed employment contracts beforehand.

Of the two who showed up for the first day, one never returned after the lunch break. She didn’t return my calls. There was no indication why - we were concerned she may have gotten into a car accident or something. That night she texted me that the hours (as written on her signed contract and emailed to her weeks ago) were unacceptable.

The second hire we had waited three weeks for her house to close, because we were (are) desperate. She gave it her all for training week and decided she didn’t like this kind of job after all. Very politely, she quit on Monday morning, effective… immediately. We were forced to cancel all of our patients for that day due to lack of staff.

We ended up re-hiring an ex-employee who had resigned years ago for personal reasons. She had been back for five days… then on Tuesday a family member she had seen over the weekend tested positive for COVID-19. This employee is now home self-isolating.

We have some patients who are nurses at other doctor’s offices. I have overheard them talking about staff shortages at their offices, ‘if Dr. X doesn’t hire somebody soon, I’m quitting. There’s only one of me.’

My employees are at their limit. I know it, they tell me. Even patients tell me. The employee that resigned in January was moving away, but the one that resigned in March almost certainly did so because she was overstressed by the staff shortage.

One thing we ask applicants who are currently employed is, why are you leaving your current job? I have noticed people are now writing, “staffing issues”.

To replace the employee who quit on Monday we are now trying to hire that seventh interviewee, who had no-showed her first interview. She has since taken another job, but doesn’t like it there. This afternoon she decided she would rather work for us after all. I asked her when she could start, and she told me next Monday…

~Max

2

What position are you hiring for? Part of my job brings me in and out of a lot of doctors offices…well, a lot consider I have nothing to do with medicine. But pre-pandemic, I was probably in a doctor’s office once a day, now it’s once or twice a week. I end up chit chatting with a lot of nurses and office managers during that time.
One thing I’ve learned is that a lot of office managers and other people that don’t need face time with patients can, and do, work from home. In fact, over the past year or so, the majority of my confirmations calls (as a patient, nothing to do with work) are coming from personal cell phones because they’re doing all the scheduling at home.

In any case, depending on what you’re looking for and how many hours they need to put in, if it’s all possible for them to work from home, maybe that’s an option. For example, if someone could do their job in, say, 2-3 hours a day from home, they could do it without quitting their current job.
OTOH, if you’re looking to hire another provider, that’s different.

My other suggestion would be to talk to people that are in and out of other offices. If you’re in an office that gets visits from drug reps, ask them how other offices are handling this situation. Half their job is talking to office staff and they pick up a lot that way.

3

And I had been working from home, until I was needed to cover the desk. The positions we are out of are patient-facing clinical staff. It’s at the point where if one person calls in sick or something, we have to cancel patients for the day (as happened on Monday).

And yeah, we just started seeing reps again last month.

~Max

4

Are you offering telemedicine? Two of my docs (GP and allergist) both do virtual/phone visits. I only talk to the doc, no nurse (no vitals/backstory etc) and the whole thing takes about 5-10 minutes.

The reps we work with have been doing virtual visits since the beginning, a few of them have started going back to in-person visits, but not many and only to the independent offices (I’m guessing you’re not affiliated with a group). The offices that are part of bigger groups aren’t doing it and, I suspect, most, if not all, will use this to as a way to put a policy in place to stop drug rep-provided lunches. A lot of them already had (years earlier) and the remaining ones had begun moving in that direction, pre-covid.

The other thought I had, and I’m just tossing it out there since it’s likely not feasible, especially since this is, hopefully, going to end sooner rather than later, is finding another office and somehow teaming up with them.
My allergist has two or three locations and they’ve started shuffling staff to where they’re needed, but they’re all still working for the same provider/employer. I’m curious if it could work with an unrelated office. If you’re short, you can have access to their staff, if they’re short, they can borrow someone from your staff.

But, yeah, pick your drug-rep’s brains. They’ll be more than happy to tell you what other places are doing. Remember, the less overworked your staff is, the more likely you are to let them come in for meetings/lunches.

5

We offer telemedicine, but it has spun down considerably since January as everyone got their vaccines. A lot of the services in our specialty require physical presence, for example to use the machine or for us to perform a test.

Ahahaha, as a small one-doctor practice it is the complete opposite here. Our doc reminisces to when the reps would fly him across the country and buy him $1,000 wines and steak dinners.

~Max

6

That was a long, long time ago. When we first got into it, the ‘trip to Pebble Beach, a Corvette will be waiting for you at the airport, condo is fully stocked with booze/food for the week and you have a tee-time at 10 on Tuesday, Wednesday and Friday’ was just winding down. Reps were allowed to take the entire office, and spouses to restaurant dinners with a $100+/person budget. Now they get something closer to $25ish per person catered lunch, in office. In some cases, the headcount can only include doctors, PAs (RPNs?). Basically the people that can write prescriptions. So an office of 20, might give the rep a budget of $200. Luckily, that’s within our wheelhouse. And, if a doc or two isn’t there to sign the sheet, it can be a real headache.
Your doc has been practicing since at least the late 90’s, right?

7

The staffing issue is a nightmare on the public practice side too. Before I resigned my Medical Director position my time was filled with trying to recruit physicians and NPs to fill all our vacancies. The state hiring bureaucracy made that process even more nightmarish, with built-in delays, inflexibility in salary/benefit offerings, and wages that were below market. Covid worsened all that.

Meanwhile just trying to fill nursing spots and office assistant positions was just as bad. We’d have half the candidates not show for the interview, many left after a day or week on the job, etc. Our RNs get forced double shifts, covid regulations mean spending even more time doing paperwork and not doing patient care, etc etc. I’ll stop my rant there.

I caught the tail end of the drug rep bribery schemes, back in the mid 80’s. It was nice but I never took much advantage of it and it seemed the right thing to do to clamp down on such practices. Especially once I found I was in charge of helping to decide what meds go on our formularies. I couldn’t reconcile such a blatant conflict of interest.

Now I just see patients, and do minimal management other than advising our current crop of medical managers, and I get to inform them why their great ideas for change and reform failed the last 3 times we tried to make headway against the bureaucracy with such ideas (and they were/are good ones). I plan to work another 12 to 15 months and then retire.

8

From the other side, my daughter (a nurse) couldn’t be happier. Her employer is bending over backwards to please nurses. If she wants to leave, she can apply anywhere and be hired. She is fully vaccinated and in a low risk field (labor and delivery).

9

At my dermatology appointment this week, I learned that two nurses, still employed in the office, have refused to be vaccinated. I’m about at the point of terminating my care with some practices if everyone working there isn’t vaccinated.

10

I’m glad I got to read your post. I work at a pharmacy, and now I realize I should be careful on what to call on and fax questions with precision and detail, so the medical office isn’t having to waste time trying to answer every fax. I thought about my recent dr visit , he’s usually a cordial guy but last visit, I felt something was off, he was curt with my questions and I figured it was behind the scenes stuff. I imagine it was the scenario you described.

11

I wonder how many waves it would create (that is, would it backfire) if when you made your next appointment you asked them to add a note that you’ll only be seen by fully vaccinated staff. If you don’t mind making waves, you could call the day before your appointment, ask for the office manager, and tell them directly that you’re not comfortable with unvaccinated nurses. You could even go so far as filing a complaint with whatever group they work with.
Out of curiosity, how did you find out? Did you overhear someone say it or did someone brag about it to you?

I’m always surprised at how many covid deniers I run across that, as part of their argument, tell us where they work. ie, “[something about covid is a lie] and I should know, I’m an ER nurse”. Every time I see that on facebook I think about getting a screenshot of it and anonymously forwarding it to their employer.

12

Another nurse told me. We have a long term professional relationship.

13

Yeah, my GP of 20+ years was trying to hide his grumpiness, but in addition to trying to deal with in-office stuff, I imagine he is also getting a ton of requests for things like letters to employers for COVID-related ADA workplace accommodations, etc. I wish he personally were more tech-savvy; I was partly there to talk about an accommodation (not COVID-related). I would have been happy to write something up for him to review and e-mail it to him to print ad sign, but he isn’t really set up for that. It might really save him a lot of time.

14

The major hospital system where our vacation home is located, announced that all of their personnel were required to get vaccinated by September(?) first, which sounded good. But then they added that they would accept medical or religious exemptions. :roll_eyes: Fat lot of good that’s going to do.

This same hospital had one of their board that they fired last year because he had got a mild case of Covid and recovered, so he publicly announced that he didn’t need to wear a mask or social distance since he was now immune.

15

I’m now wondering about my doctor’s office, who has had reduced hours for the last 6 months. I don’t know if it is due to 1) making it required that all workers are vaccinated 2) too many workers are high risk (the founder of the practice has been ramping down for the last 2 years as he moves towards retirement or 3) too many patients and they need to pace themselves.

I have no idea, but before all this started, they were always open over lunch, which is actually unusual. But they specifically state that they have reduced hours because they do not have enough personnel, but they don’t say specifically which personnel are missing, and why they haven’t been able to get more.

Also, it could be because they are also feeding the vaccination clinics. They were giving vaccines at the practice, but have stopped this as well due to the overhead.

16

Yeah, I think the anti-kickback for drug reps was in 2002 or 2003 but my doc has been practicing since the '90s.

(I inherited swag that dates from the early 2000s: clocks, mugs, clipboards, etc.)

~Max

17

It began declining tremendously in the late 80’s. the group I joined in 1987 was restricting their displays for us and what they could offer. Occasional lunches and pens and desktop doohickeys, no trips, nothing of much value. the crackdown on free samples came later though

18

Were you in public healthcare back then too? That might explain the difference.

I think the deal with my doc was, the pharmaceutical companies would sponsor a conference, and the conference would fly you across the country for a lecture or something, to show off new work/research about the drug. Once there they give all the docs a steak dinner.

~Max

19

An update on the actual topic of staffing a doctor’s office during COVID-19. Said unvaccinated employee with COVID exposure finished her quarantine and is now back in the office. The day she came back, another employee slipped and fell on an oil slick and had to take a few days off to heal (doctor’s orders).

The employee we were trying to hire apparently had some sort of health issue and won’t be able to start for two weeks. She sent details to bossman but we don’t really care enough, at this point a two week waiting period is business as usual.

So, miraculously, we are still down two staff. I didn’t mention this before, but of 8 positions, four of them are clinical ancillary (nurses but not necessarily LPN/RN). Two are practitioners (MD + ARNP) and two are nonclinical (me and a dedicated receptionist). We normally keep two nurses in each office. Of the two positions empty right now, two of them are nurse positions.

We’re doing much better now than earlier this year. The receptionist had a death in the family and one of the two nurses had a long-planned vacation. For a time we were operating two offices with one receptionist and one part-time nurse - fun!

~Max

20

no, that was during my 19 years in the private sector